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What are tension headaches?

Tension headaches are usually associated with emotional upsets or stress, which can occur at home or at work. They may be aggravated by abrupt changes in environment or life style. In a tension headache, the muscles at the temples contract and go into spasm, creating a vise-like sensation around the top of the scalp and causing a steady, nonthrobbing pain in the head.

What causes tension headaches?

The pressures of everyday life appear to engender these headaches. Too hard a day at work, too much commotion from the children, a school exam, or a job interview are a few of the many stresses that can trigger a tension headache.

Recent research indicates that other factors may be involved, too. Some studies suggest that people who suffer tension headaches, as with those who develop migraines, have an inherited disturbance in brain chemistry. In this view, the tight scalp muscles characteristic of tension headaches are the result, rather than the cause, of the disturbance inside the skull.

How are tension headaches diagnosed and treated?

Persons who suffer from these headaches are usually well aware of them, and may have a clear sense of the precipitating cause. A medical examination and tests such as a CT (computed tomography) scan may be advised, however, to rule out a serious physical cause.

Treatment may entail relaxation techniques such as yoga or meditation, and drugs to ease tension and muscle spasms. There also are special medications, such as butalbital (Fiorinal), that are formulated especially for tension headaches.

What can I do myself?
If you've started to develop headaches at work or in other daily situations, ask yourself whether the lighting, furniture, or some other environmental

factor is triggering or contributing to your discomfort. If you wear glasses, are they fitted properly, and have the lenses been checked? (In some instances, eye strain may be the source of tension headaches.)

Do the headaches recur at a particular time each day? If so, perhaps a work break or time out for physical exercise — swimming, jogging, or simply walking around the block — will reduce your tension and relieve the head­aches. A break for meditation or for quietly listening to music may help you deal with the stress, and reduce or eliminate the headaches. Massage, especially at the base of the skull, can also help relieve tension and ease the muscle spasms that may cause headaches.

When should I see my doctor?
If the headaches persist and you are unable to relieve them, a doctor should be consulted promptly.

What will the doctor do?
The doctor begins by asking detailed questions about when and how the head­aches come on. He or she may ask where the pain occurs, how long it lasts, and what alleviates it.

A physical examination may also be needed. The doctor may try to locate muscles that are sore from spasm by pressing gently on the temples. If soreness is present, there is a good chance that the headache is due to tension.

Other physical and emotional causes of the pain should be ruled out. The location and intensity of the pain are important clues in this process. Tension headaches are moderate in intensity. In addition, they do not throb, and they tend to come and go. The pain may travel in a line from the front to the back of the head, or it may seem to involve

the entire skull. Typically, a tension headache sufferer feels as if a band of cloth has been tightened around the head.

A CT scan or other internal imaging studies may be done to rule out other causes for the head pain. When satisfied with the diagnosis, the doctor may suggest counseling or brief psychotherapy to help reduce the stress and anxiety that may be triggering the symptoms. Pain relievers such as aspirin are of little or no value in relieving tension headaches.

A prescription tranquilizer or muscle relaxant is more likely to be effective.

The course of tension headaches

Many people experience these headaches in times of extra stress, then lose them when life quiets down. If the headaches continue and are not relieved by self-help or simple treatments, a headache specialist or other neurologist should be consulted.

Are tension headaches dangerous?
They pose no threat to life or general health, but they do indicate that life's problems may be getting out of hand. It may be helpful to consult a mental-health professional to find ways of resolving these difficulties and enjoying renewed well-being.